Point-of-care testing for drugs of abuse in an urban emergency department

Point-of-care testing (POCT) has been used for illicit substance screening in several settings, primarily in law enforcement and drug treatment centers. In this study, we evaluate the use of this screening approach in the emergency department (ED) of a tertiary-care, urban medical center. Aliquots of urine specimens were tested simultaneously by a POCT device (OnTrak(TM)) and by a laboratory-based screening system (Triage(TM)). The outcomes that were compared included (a) time to completion of test, (b) time until the physician received the results, and (c) concordance of results obtained by the two analytical methods. The study population included pediatric (less than or equal to 21 yr) and adult (> 21 yr) patients; data from 170 subjects were evaluated. We observed significant reductions (p<0.001) in turnaround time (both the time to completion and the time to physician). Concordance between the results obtained by the two analytical methods was excellent (97% agreement for cocaine; 99% agreement for marijuana, opiates, and amphetamines, p<0.001 for all categories). Cost analysis showed at least 37.5% decrease in cost per analyte when urine samples were tested by the POCT device, compared to the laboratory-based screening system. We conclude that POCT for drugs of abuse in the ED was equally effective, less costly, and more rapid than the laboratory-based screening system. (received 29 January 2002; accepted 10 April 2002).